The Impact of School Water Access on Child Food and Beverage Intake and Obesity

 描述（由申请人提供）：保持健康的体重对幼儿很重要，因为儿童肥胖是成年肥胖和相关慢性疾病的预测。摄入含糖饮料（SSB：苏打水，调味牛奶，水果味饮料和其他添加糖的饮料）是肥胖的主要原因。这对于低 收入家庭的孩子更容易喝SSB和肥胖。儿童在学校度过大量时间，他们每天消耗高达50%的热量，包括来自SSB的热量。因此，许多肥胖预防工作的目标是减少学校的SSB摄入量。最近，科学权威还建议学校改善饮用水和免费饮用水的供应-一种替代SSB的健康选择-作为一种低成本和可行的肥胖预防策略。新的政策也要求学校提供水，但执行情况很差。尽管2010年的《健康无饥饿儿童法案》要求参加联邦膳食计划的学校在提供膳食的地方提供免费的饮用水，但25%的美国学校仍然没有做到这一点。即使在提供免费饮用水的学校，由于担心清洁或水质不达标，也可能避免使用饮水机。虽然在学校促进饮用水摄入是一种合理的肥胖预防策略，但没有大型研究系统地研究这种策略如何改变提供SSB和果汁的学校中儿童的整体饮食模式和肥胖率。我们的中心假设是，在小学，增加淡水的供应和严格促进其消费将减少学生摄入的热量饮料，从而降低肥胖率。为了验证这一假设，我们将在旧金山弗朗西斯科湾区的26所低收入小学进行一项随机分组试验，其中13所学校将接受水促进干预，13所学校将作为对照。该干预措施基于社会认知理论和PRECEDE-PROCEED模型，并在我们的团队先前的发展研究中培养，通过以下方式促进水的消耗：1）在食堂、体育活动场所和交通繁忙的公共区域安装无铅水站，2）为学生提供杯子和可重复使用的水瓶，3）开展为期6个月的健康教育活动，包括开球，课堂课程、家庭作业活动、标识和奖励。从基线到干预开始后9个月和15个月，我们将测量以下方面的差异：1）水摄入量（观察和测量从水源中获取的水）2）食物和饮料的总热量摄入量（24小时食物和饮料日记）和3）干预学校和对照学校学生之间的超重/肥胖患病率。如果拟议的学校用水干预措施有效，我们可以为学校官员提供一个可行的和低成本的肥胖预防工具。美国学校将很快被联邦政府授权重新评估他们的健康政策，以实施新的食品和饮料法规。这项研究提供了一个及时的机会，为领导者提供一个以证据为基础的战略，以改善学生的营养和健康。

 DESCRIPTION (provided by applicant): Maintaining a healthy weight is important for young children because childhood obesity is predictive of adult obesity and related chronic illness. Intake of sugar-sweetened beverages (SSBs: sodas, flavored milks, fruit-flavored drinks, and other drinks with added sugar) is a major contributor to obesity. This is particularly true for low income children who are more likely to drink SSBs and to be obese. Children spend substantial time in schools where they consume up to 50% of daily calories, including those from SSBs. Consequently, many obesity prevention efforts have targeted reductions in SSB intake in schools. Recently, scientific authorities have also recommended that schools improve the availability of potable and free drinking water - a healthy alternative to SSBs - as a low-cost and feasible obesity prevention strategy. Emerging policies also mandate water access in schools; but implementation is poor. Although the 2010 Healthy, Hunger-Free Kids Act requires schools participating in federal meal programs to provide free potable water where meals are served, 25% of US schools still fail to do so. And even in schools that offer free water, drinking fountains may be avoided due to concerns about cleanliness or sub-standard water quality. While promotion of drinking water intake in schools is a plausible obesity prevention strategy, no large studies have systematically examined how this tactic can change children's overall dietary patterns and obesity rates in schools that offer SSBs and juices. Our central hypothesis is that in elementary schools, increased access to fresh water and rigorous promotion of its consumption will reduce student intake of caloric beverages, thereby leading to lower rates of obesity. To test this hypothesis, we will conduct a cluster-randomized trial in 26 low-income elementary schools in the San Francisco Bay Area, in which 13 schools will receive a water promotion intervention and 13 schools will serve as controls. The intervention, based on Social Cognitive Theory and the PRECEDE-PROCEED Model and cultivated in prior developmental studies by our team, promotes water consumption by: 1) installing lead-free water stations in cafeterias, physical activity spaces and high-traffic common areas, 2) providing cups and reusable water bottles for students, and 3) conducting a 6-month health education campaign that includes a kick-off play, class lessons, family homework activities, signage, and rewards. From baseline to 9 and 15 months after the start of the intervention, we will measure differences in: 1) water intake (observations and measurements of water taken from water sources) 2) total caloric intake from foods and beverages (24-hour food and beverage diaries) and 3) overweight/obesity prevalence between students in intervention and control schools. If the proposed school water intervention is effective, we can provide school officials with a feasible and low-cost obesity prevention tool. US schools will soon be federally mandated to reevaluate their wellness policies in order to implement new food and beverage regulations. This study presents a timely opportunity to provide leaders with an evidence-based strategy for improving student nutrition and health.